Not a single veterans service organization was asked to speak last week at the House Veterans Affairs Committee’s hearing on the final recommendations of the VA Commission on Care, though such groups represent millions of former military personnel.
Also noticeably absent from the witness list was Vietnam veteran Michael Blecker, executive director of the San Francisco veterans group Swords to Plowshares, who served on the Commission on Care, and who dissented from its final report. Blecker objected that the commission’s leading recommendation—the creation of a so-called VHA Health System network of private-sector care providers—could fatally weaken veterans’ health care.
Instead, Committee Chair Jeff Miller, a Florida Republican, invited only two people to testify before the panel: Delos “Toby” Cosgrove, vice chair of the commission and CEO of the Cleveland Clinic, and Commission Chair Nancy Schlicting, who is CEO of the Henry Ford Health System. Miller happens to be a faithful supporter of Donald Trump, who has touted the VA committee’s chairman as his top pick as secretary of veterans affairs in any Trump administration.
While Schlicting has expressed support for the VHA, Cosgrove was one of the leaders of a commission faction—what some have dubbed the “Strawman” group—that favored the complete elimination of the VHA.
At the hearing, which took place on September 7, Cosgrove and Schlicting both expressed enthusiasm for creating a VHA Care System that ostensibly would create a network of private-sector providers to deliver health care to veterans while also somehow integrating them into the VHA. The report estimates that this system would eventually channel up to 60 percent of veterans into private-sector health care, and even acknowledges that the new setup would potentially weaken the VHA itself.
Alarmingly, all the Democrats on the committee—with one notable exception—voiced support for this general policy direction, albeit with less ideological fervor than Miller and his GOP colleagues. The one committee member who spoke out against the plan—fortunately for veterans—was ranking Democrat James Takano, of California, who expressed serious reservations about the proposed VHA Care System, and echoed concerns about it that have already been raised by President Barack Obama and by VA Secretary Robert MacDonald.
The other panel Democrats came across as shockingly misinformed, and offered such VHA fixes as Texas Representative Beto O’Rourke’s argument that the VHA should only concentrate on service-related mental and physical health conditions, rather than routine primary care. If treatment of veterans were limited in this fashion, many service-related conditions that experienced VHA providers now identify in primary care visits would go undetected. Such conditions would be far less likely to be diagnosed by private-sector providers, who often have little knowledge of military/veteran problems. As Blecker has pointed out, if Vietnam veterans were dependent on the private sector, PTSD and problems related to Agent Orange, which the VA itself took too long to identify, may never have been recognized and researched at all. (Having learned from its Vietnam experience, the VHA has been quick to identify and act to treat traumatic brain injuries, the signature injury of the wars in Iraq and Afghanistan.)
Also alarming was Veterans Affairs Committee members’ bipartisan embrace of the recommendations by Cosgrove and Schlicting that the VHA abandon its highly successful in-house system of electronic medical record-keeping (which it is working to improve) and replace it instead with commercial products. Lobbyists for companies that produce these systems have spent millions urging hospitals to purchase their wares—despite the fact that, as a large body of research has documented and as a recent JAMA editorial underscored, they have largely failed to fulfill their promise of creating safer and more efficient health care.
“The systems being proposed for purchase at the VHA have been widely disparaged by medical professionals and patient safety advocates for their lack of user friendliness, failure to consider clinical workflow and [prioritization] of billing information over care,” Ross Koppel, an expert in health-care information technology at the University of Pennsylvania, told The American Prospect.
During the hearing, no member of Miller’s committee expressed concern about the estimated 300,000 veterans whose military discharges—sometimes due to service-related mental health problems—leave them barred from the VHA. The Commission on Care recommended that some veterans with other than honorable discharge receive tentative eligibility for health-care services.
All in all, it was disappointing day for vets on Capitol Hill. It was also a warning of what’s in store for veterans if Trump, who has not only floated Miller as VA secretary but has revealed his own ignorance of veterans’ health-care issues, becomes commander-in-chief on Election Day.